CHAPTER 11

Almost 10% of today’s older adult population is anemic (1). Anemia is more common among frail elderly persons but does not always reflect a serious underlying condition, known as unexplained anemia, which does not meet diagnostic criteria for a specific etiology (2). In the nursing facility, anemia preva- lence approaches 50% or higher. Anemia can be found in as many as one-third of all hospitalized older adults and presents with physical signs such as weak- ness, shortness of breath, and a generalized feeling of tiredness (3). These symptoms, in combination with other common difficulties found in the older adult population—such as sarcopenia, rheumatoid arthritis, and side effects from polypharmacy—can lead to severe impairment in completing activities of daily living and can lead to progressing states of inadequate nutritional status (1,3-6).

Most anemias are caused by a lack of nutrients required for normal erythrocyte synthesis, predomi- nantly iron, vitamin B-12, and folic acid. Those receiving dialysis related to kidney failure; those with intestinal diseases such as ulcerative colitis, celiac disease, or atrophic gastritis; those who have partial or total gastrectomy; those who have drug interference; those with subsequent intestinal blood loss; and those suffering from infection or chronic disease/inflammation may all be at risk for iron defi- ciency. Achlorhydria, often seen in 30% of older adults, may decrease absorption of iron. Multiple conditions can lead to anemia in older adults, and it may also be multifactorial. It is vital for registered dietitian nutritionists (RDNs) to be able to accurately identify the etiology of anemia and recom- mend appropriate interventions in a timely manner. Progressive, untreated anemia can result in cardiovas- cular and respiratory changes that can eventually lead to cardiac failure. Anemia has also been associated with functional impairment and physical decline,

Anemia and Its Effect on the Older Adult

reduced mobility, decreased quality of life, depres- sion, falls, decreased activities of daily living and instrumental activities of daily living, worsening comorbidities, increased hospitalization, and morbid- ity (3,6-8). Table 11.1 shows the prevalence of various etiologies of anemia in older adults. There is a decrease of iron in red blood cells (RBCs) with aging (9). The amount of iron absorbed

TABLE 11.1 Prevalence of Various Etiologies of Anemia in Older Adults

Cause

Anemia of chronic disease Chronic disease/inflammation Endocrinopathies Iron deficiency

Myelodysplastic syndromes No identified cause Renal Insufficiency

Prevalence 30%–40%

19.7%–35% < 5%

15%–30% 0%–5%

15%–33.6% 8.2%

Vitamin B-12 or folate deficiency 5%–10%

Sources: Joosten E, Pelemans W, Hiele M, et al. Prevalence and causes of anaemia in a geriatric hospitalized population. Geron- tology. 1992;38(1-2):111-117; Artz AS, Fergusson D, Drinka PJ, et al. Mechanisms of unexplained anemia in the nursing home. J Am Geriatr Soc. 2004;52(3):423-427; Smith DL. Ane- mia in the elderly. http://www.aafp.org/afp/2000/1001/p1565. html. Accessed Feb 11, 2016; Bross MH, Soch K, Smith-Knup- pel T. Anemia in older persons. http://www.aafp.org/ afp/2000/1001/p1565.html. Accessed February 11, 2016.